Coping with OCDLily Pad Psychology Clinic TM

Adult Program

June 2015

LEAP Series

This OCD Treatment Program is part of Lily Pad’s ‘Leap’ therapist supported program.

Clients access our treatment manual online and work through the sections in their own time, and review their progress with their therapist.

The Program is set out week by week over a 6 session plan.

You are welcome to access the program and complete it alone, however results are best achieved with therapist support.

We are not responsible for the success of this program with out the support of our therapist.

Welcome to the Program

Welcome! We are so glad you’ve leapt into this program!

Lily Pad Psychology Clinic works by the philosophy that we ‘bounce’ through life’s up’s and down’s and that Psychological reflection and support are best utilised when we feel we are getting stuck in a rut and need to gain insight and strategies to jump off the ‘lily pad’ again (so to speak) and leap back into life! Hence, our name ‘Lily Pad Psychology Clinic’.

I have designed this program to be a basic manual to support the therapy you are receiving with myself.

Please work through this program in-line with the sessions we have together, of course we can skip parts and spend more time on parts you may need/want to focus on. We can also spend time on topics outside of this manual, that you may want to explore, as we go through. I am trained in lots of forms of therapy including ACT, CBT, DBT, Schema Therapy, Brief Solution Focused Therapy and Psycho-education and I provide individual, couples and family treatment, so we can use a mix of what you are wanting to get the best outcomes.

There are resources attached to this program that are free to download, many of these resources will be valuable tools for you to use regularly to overcome the challenges of OCD. I will also direct you to other online resources, that are also useful, for your exploration.

Week 1: Do I have OCD?

Lily Pad Psychology Clinic TM

Adult Program

June 2015

What is OCD?Most individuals with obsessions develop compulsive rituals in order to relieve their anxiety or to prevent some dreaded consequence. Common compulsions include washing, checking, reciting particular phrases, hoar- ding, redoing or repeating particular actions. Compulsions are fairly repetitive, rigid behaviors or mental responses that the person may initially try to resist but will eventually give into because of a strong inner urge to perform the ritual. Ninety percent of individuals with OCD have both obsessions and behavioral compulsions, with 25-50% reporting multiple obsessions. Dirt/contamination obsessions and washing/cleaning compulsions, as well as pathological doubt and checking rituals are by far the most common OCD symptoms, although up to 25 % of individuals with OCD may have obsessional rumination without overt, behavioral compulsions.

OCD occurs with approximate equal frequency in men and women. The condition typically begins in late adolescence with young adults between 18 and 24 years at highest risk. However OCD can occur in early adolescence and childhood. Once the disorder begins, it tends to take a chronic course with the symptoms waxing and waning over many years. OCD tends not to disappear on its own but the symptoms will increase or decrease depending on the level of stress in one’s life. OCD varies in intensity with the moderate and more severe forms of the disorder often having a significant negative effect on intimate and family relationships. Often family members are drawn into the person’s obsessional condition with requests for reassurance that the dreaded con- sequence will not occur (e.g., a daughter may demand that her mother wash all her clothes three times in order to ensure they are perfectly clean and not contaminated with dirt and germs).

Origins of OCD

There is no known specific genetic, biological or psychological process that uniquely causes OCD. It is likely that individuals inherit a predisposition for developing anxiety more generally. There is also evidence that particular brain structures and neurochemical pathways are involved in the anxiety disorders. Also it may be that some individuals develop OCD after experiencing a critical life event relevant to their obsessional concerns. However it is still unclear why someone who tends to be anxious develops OCD instead of another anxiety disorder like social phobia or panic disorder.

Treatment of OCD

There are currently two approaches to the treatment of OCD that research has shown to be effective in reducing the severity of obsessive and compulsive symptoms. The first involves the use of medication and this is probably the treatment that most Canadians with OCD receive either from their family physician or psychiatrist. Effective medications for obsessive-compulsive symptoms include clomipramine, although tolerability may be a problem in some individuals. The newer selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, sertraline, paroxetine and the serotonin and norepinephrine reuptake inhibitors ( SNRIs) such as venlafaxine have fewer side effects and are almost as effective in reducing obsessions and compulsions as clomipramine. These medications may take up to 10 to 12 weeks of treatment or longer, before a significant improvement is seen in approximately 70 % of individuals who complete treatment. However complete elimination of symptoms is rare and up to 90% of individuals will relapse when the medication is discontinued.

Treatment of OCDThe second treatment shown to be effective for OCD is a form of psychological treatment called cognitive-behavior therapy (CBT). This consists of 15-20 weekly one hour sessions with a trained therapist in which the person is systematically exposed to their obsessional fear and learns how to tolerate their aroused anxiety without engaging in the compulsive ritual. Exposure to the obsessional fear is gradual and daily homework assignments are given between sessions.

In addition the person with OCD learns to decatastrophize the obsessional concern and to reduce their attempts to control the obsessional thoughts (called response prevention). The goal of this therapy is to teach the individual with OCD how to respond to their obsessional concerns in a healthier, more adaptive fashion. For example, the person with obsessional fears about contamination and who engages in compulsive washing would be exposed to successively more anxiety-provoking situations (e.g., touch doorknobs, allow clothes to touch the ground, handle money, etc.) and encouraged not to wash after the exposure. In this way he/she learns that the anxiety will naturally dissipate even without washing, and that thoughts of contamination in the end should not be treated as a significant personal threat. Exposure and response prevention CBT is effective in 80% of individuals with OCD who complete treatment and relapse of OCD is lower for CBT com- pared to medication. There is some evidence that the combination of medication plus CBT is more effective than medication alone. However one problem is that many individuals with OCD refuse CBT because they fear a short-term increase in anxiety.

Treatment of OCDOCD is a chronic anxiety disorder that can cause substantial distress and interference in a person’s life. Although it rarely subsides completely on its own, there are now effective medical and psychological treatments for this condition. Individuals who take medication for their OCD should do so under the direction of their family doctor or psychiatrist. It is important that any changes in the dosage of your medication be done in consultation with your physician. CBT for obsessions and compulsions is available in many parts of the country, however not all psychologists or other mental health professionals are trained in this treatment approach. If seeking psychotherapy for OCD, be sure to ask your counsellor his or her treatment approach, level of training and experience in OCD.

Practical books on OCD

The following are some practical resources and websites you might find helpful :

Purdon, C., & Clark, D. A. (in press). Overcoming obsessive thoughts : How to gain control of your OCD. Oakland, CA : New Harbinger Publications.

Antony, M. M., & Swinson, R. P. (1998). When perfect isn’t enough : Strategies for coping with perfectionism. Oakland, CA : New Harbinger Publications.

Foa, E. B., & Kozak, M. J. (1997). Mastery of obsessive-compulsive disorder : Client workbook. San Antonio, TX : The Psychological Corporation.

Hyman, B. M., & Pedrick, C. (1999). The OCD workbook : Your guide to breaking free from obsessive-compulsive disorder. Oakland, CA : New Harbinger Publications.

Steketee, G. (1999). Client manual. Overcoming obsessive-compulsive disorder : A behavioral and cognitive protocol for the treatment of OCD. Oakland, CA: New Harbinger Publications.

Helpful Websites on OCD

The following are some practical resources and websites you might find helpful :

Anxiety Disorders Association of Canada : http://www.anxietycanada.ca http://www.adaa.org/

Anxiety Disorders Association of America :

Canadian Psychological Association:

http://www.cpa.ca/factsheets/OCD.htm http://www.mayoclinic.com/ http://www.ocfoundation.org/ http://www.academyofct.org/

Mayo Clinic:

Obsessive Compulsive Foundation :

The Academy of Cognitive Therapy :

Ontario Obsessive Compulsive DisorderNetwork :

http://www.oocdn.org/ http://www.ataq.org

Self Assessment

Y-BOS

Week 2: To be Continued..

Lily Pad Psychology Clinic TM

Adult Program

June 2015

Week 3: To be Continued..

Lily Pad Psychology Clinic TM

Adult Program

June 2015

Week 4: To be Continued..

Lily Pad Psychology Clinic TM

Adult Program

June 2015

Week 5: To be Continued..

Lily Pad Psychology Clinic TM

Adult Program

June 2015

Week 6: To be Continued..

Lily Pad Psychology Clinic TM

Adult Program

June 2015